The Ochsner journal
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The Ochsner journal · Jan 2015
It Takes Two to Tango: Improving Patient Referrals from the Emergency Department to Inpatient Clinicians.
The transfer of responsibility for patient care across clinical specialties is a complex process. Published and anecdotal data suggest that referrals often fail to meet the needs of one or both parties and that patient focus can be lost during the process. Little is known about the Australian situation. ⋯ Respondents attributed the difficulty of negotiating the transfer of a patient's care across the ED and inpatient interface to three distinct factors: variations in the clinical information required, the culture of the organization and of the clinical team in which the transaction takes place, and the characteristics of the individuals involved in the process. Improving communication skills has the potential to improve patient outcomes.
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The Ochsner journal · Jan 2015
ReviewClinical Comparative Effectiveness Research Through the Lens of Healthcare Decisionmakers.
Healthcare expenditures in the United States exceed the healthcare expenditures of other countries, yet relatively unfavorable health outcomes persist. Despite the emergence of numerous evidence-based interventions, wide variations in clinical care have caused disparities in quality of care and cost. Comparative effectiveness and cost effectiveness research may better guide healthcare decisionmakers in determining which interventions work best, for which populations, under which conditions, and at what cost. ⋯ Learning health systems and practice-based research networks provide the infrastructure for advancing CER methods, generating local solutions to high-quality cost-effective care, and transitioning research into implementation and dissemination science-all of which will ultimately guide health policy on clinical care, payment for care, and population health.
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Treatment of trigeminal neuralgia can be challenging for many physicians; patients who do not respond to conventional treatments and traditional surgical approaches often continue to suffer with pain. The peripheral nerve stimulator (PNS) has been used to treat many chronic pain conditions, but few reports exist about its use to treat trigeminal neuralgia. ⋯ PNS implantation can be a safe and effective method to treat trigeminal neuralgia. More research is needed to define its mechanism of action.
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The Ochsner journal · Jan 2015
Amputation as an Unusual Treatment for Therapy-Resistant Complex Regional Pain Syndrome, Type 1.
Complex regional pain syndrome, type 1 (CRPS-1) causes severe pain that can be resistant to multiple treatment modalities. Amputation as a form of long-term treatment for therapy-resistant CRPS-1 is controversial. ⋯ Select patients with severe CRPS-1 who are unresponsive to all forms of treatment for pain may benefit from amputation as a last option for relief of suffering. Larger studies are needed to prove the efficacy of amputation.